Volume 25, Issue 2

TMA/TSA putting the Stop on SCOPE Expansion: Summary of the Scope of Practice Legislation in Texas 2013

This session was marked by a flurry of scope-of-practice bills by allied health professionals looking to practice beyond their expertise, whether it was chiropractors attempting to conduct mental and physical examinations of school bus drivers, physical therapists seeking direct access to patients without a diagnosis, or pharmacists trying to vaccinate children.

Those efforts went nowhere, however, due to TMA’s vigilance at the Capitol and to a new collaborative standard TMA and key lawmakers set for addressing scope-of-practice issues.

Senate Bill 406 (Nelson-R-Flower Mound) replaces current site-based restrictions for prescriptive delegation and supervision with a more flexible, collaborative model for physician-led, team-based care. The legislation resulted from months of negotiations among TMA, the Texas Academy of Family Physicians, advanced practice registered nurses, and physician assistants spearheaded by Senator Nelson and Representative Kolkhorst.

TMA never deviated from the core principle that diagnosing and prescribing remain the practice of medicine, TMA Director of Legislative Affairs Dan Finch says. However, by bringing together various parties on a pre-session compromise, “what we did was change the conversation. Now we have a process and a model for future scope-of-practice discussions.”

The bill was the result of cooperation between TMA, TAFP and the APRN group and is based on these core principles:

Independent diagnosis and prescribing is the practice of medicine. Physicians may delegate, but must supervise. Because, ultimately, physicians are accountable.

It is a delegated model for prescribing privileges for APRNs and PAs. And it drives both the responsibility and the flexibility for delegation and supervision specifically to the physician. More broadly, it supports the concept of the physician led health care team as a way forward in providing greater access to care.

In general the bill does away with the current site based system for delegation and supervision in the general community while maintaining the existing structure for delegation and supervision within facilities.

  • Allows a physician to delegate prescribing authority to up to 7 APRNs/PAs, or their full time equivalents
  • Replaces the site based requirements with a requirement that the physician and delegates meet monthly for a documented quality assurance meeting. Provisions are included to address the delegation, supervision and documentation of QA meetings for APRNs/ PAs within a defined group.
  • Requires the physician and APRN/PA to sign a prescriptive authority agreement that details – either by inclusion or exclusion – the specific drugs or classes of drugs that the APRN/PA may prescribe, or not

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